Fecal microbiota transplantation: indications, methods, evidence, and future directions

Thomas J Borody, Sudarshan Paramsothy, Gaurav Agrawal, Thomas J Borody, Sudarshan Paramsothy, Gaurav Agrawal

Abstract

Fecal microbiota transplantation (FMT) has attracted great interest in recent years, largely due to the global Clostridium difficile infection (CDI) epidemic and major advances in metagenomic sequencing of the gastrointestinal (GI) microbiota, with growing understanding of its structure and function. FMT is now recommended as the most effective therapy for relapsing CDI and, with further refinement, may even be used in "first-time" CDI. There is interest also in other conditions related to GI dysbiosis--for example, inflammatory bowel disease, irritable bowel syndrome, obesity, and diabetes mellitus--although quality evidence is at present lacking. A few trials are now underway in FMT for ulcerative colitis. Many unanswered questions remain, including FMT methodology--for example, optimal route of administration, what makes a "good donor," safety issues, and long-term effects of FMT.

Conflict of interest statement

Thomas J. Borody has a pecuniary interest in the Centre for Digestive Diseases, where fecal microbiota transplantation is a treatment option for patients, and he has filed patents in this field.

Sudarshan Paramsothy declares that he has no conflict of interest.

Gaurav Agrawal declares that he has no conflict of interest.

Figures

Fig. 1
Fig. 1
A 33-year-old male with ulcerative colitis presented with abdominal pain, bloody diarrhea, and mucus discharge. Failing standard antiinflammatory drugs with frequent relapses, fecal microbiota transplantation (FMT) was introduced. FMT was first administered via a transcolonoscopic route followed by daily enemas, reducing to twice weekly, weekly, and then fortnightly. After 80 FMT infusions, he was passing normal stool once per day and was off all drugs for 7 months. He was recolonoscoped, and the difference is shown
Fig. 2
Fig. 2
A 14-year-old boy with Clostridium difficile and severe Crohn’s ileitis poorly controlled on prednisone and azathioprine was treated with fecal microbiota transplantation, with a total of 60 home infusions. He experienced marked clinical improvement, and, incidentally, his severe facial acne also healed within 7 days. Ileoscopy showed pronounced improvement in the inflammation, and Clostridium difficile infection cure was confirmed upon stool testing

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Source: PubMed

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